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Court Declares CDPAP Fiscal Intermediary Fee-for-Service Rate Decrease Null and Void

Advocates for fiscal intermediaries (FIs) and New York’s Consumer Directed Personal Assistance Program (CDPAP) obtained a favorable judgment late last week in an Article 78 proceeding challenging the Department of Health’s (DOH) reductions in administrative rates for FIs serving the CDPAP program. Judge Christina Ryba declared the Department's July 1st Managed Care Policy containing the Per Member Per Month (PMPM) tiered reimbursement structure null and void. The court ruled that DOH must follow the State Administrative Procedure Act (SAPA) regulatory process before such an action may be taken.

Pursuant to the final 2019-20 State Budget, the State was seeking to implement a PMPM rate structure for CDPAP FI administrative services effective Sept. 1, 2019. DOH issued Managed Care Policy 19.01 providing guidance on the rate structure, along with requirements that plans must meet in assisting members who are transitioning from one FI to another (available here). Stakeholders voiced significant concerns regarding the timing and financial implications of the guidance. The Consumer Directed Personal Assistance Association of New York State (CDPAANYS), the New York State Association of Health Care Providers (HCP), and several organizations serving people with disabilities challenged the rate structure in an Article 78 proceeding.

The lawsuit’s main focus was CDPAP Fee-for-Service (FFS) rates (even though the policy referenced in the decision is entitled “Managed Care Policy”). LeadingAge NY will be reviewing the potential implications of this decision for managed long term care (MLTC) and will update providers and plans in the near future. To read the decision, click here.

Contact: Meg Carr Everett, meverett@leadingageny.org, 518-867-8871